05010052BUILDING DIVISION PERMIT
SANTA CLARA VALLEY CORP Ipp'("b5020052
NAME:
1 thereby affirm that I am paved under provisions of Chap er 9 (cemmencing
With Section 7010).(Division 3 of the Busineumd Professions Code, and my license Is
in full sera eRal
ce �Be,�ryg' DEMO
Linse force a s IJC.I
I understand my plans "I be used at public records
OWNER- BUILDER DECLARATION
I hcmby olnm that I am eampt from the Conuaclor's License Law for the
following won. (Section 70313. Business and Professions Code: My city or county
which reyulma a permit m communist. alter. hormone. dem.l W, v repair my sonemre
prim m its issuance, also requires the applicmt for such hermit to fik a signed suument
that he is licensed pursuant o the provisions of the C.nummri License law (chapter 9
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
that he is exempt them(= and the bob fm the alleged exemption. My violation of
Section 7031.5 by any applicant for a permit subjects de applicant in a civil penally of
nm mom dun flue hundred dolWs ($500).
and! Professions Code: The Ci num on Liam law dons set apply to an owner of
pmpeny won build$ of lmponnes on,aM who day amh work himself or through hit
Own employees, provided Nat such Improvements are not invaded moRered forule If,
however, the building or improvement issuld within arm )ens of completion, the owner.
builder will have the burden of proving that M did not build or Improve for purpose of
sale.).
❑ 1, an owner of de property, am emluively contracting with Renewed anumun he
construct the project (Sec. 7044, Business and Prolusions Code) The Conl WWS LI.
cave law does not apply m an owner of property who build, or Improve, themon. and
who contracts for such pmkm with acentrmlor(s) licensed pursuant to dv Contnemrs
LIcenm law.
I sm exempt under Sec ,B k P C for this won
Owner Dam
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following deck roions:
1 haw and will maintain •Certificate of Consul be serf -inure for Worle r$Compen-
ution, u Provided for by Section 3700 of the labor Cade, for the performance of tho
and will maintain Washes Compensation hose rang, an required by section
e labor Code. Ise the performance of the work for which this permit is Issued,
COMPENSATION INSURANCE
(fhb sMion need set he compleud trim permh is free. hundoold.11. ($100)
or less.)
I certify that in the perfmmance of the work for which this permit is Wad, l shall not
employ anypemon in my mutt, an as to bco omembjecl Mine Workers' Compensation
Laws of Califomia. DM
Applicant
NOTICE TO APPLICANT: IL after making this Cenlficau of Exemption, you should
become subject in the Woheri Compensation provbions of the labor Code, you most
.J O forthwith comply with such provisions v dent Permit Nall he domed m oku.
4 r~y CONSTRUCTION LENDING AGENCY
[—r 1 hereby afErne that them is a construction lending agency for the performance of
O(i � the wmk for which taus permit ts issued (Sec. 3057. Ch, C.)
WW Q Ludoes Name
Q Z Lenders Addmu
(.p Q 1 cenify Nu 1 haw read this application and mu that the above information is
Igo COMM. I qme to amply with all city and county ordinances and state laws relating to
Q building construction, and hereby authorise repwnutiwa of deb city in cola upon be
Ig7 ahove-mentioned property for inspection purposes
G (We) agree to save, indemnify and keep harmless the City of Cupertino against
y liabllides. judgments, costs and expenses which may in any Way acme against said City
V'& In consequence of the grunting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
DISCLOSURE
Will the applicant at futue building occupant use equipment m devices which
vaNnu air contaminants u defined by du Bay Ares All Quality Management
7 l
0 Yes rHI Nu
1 have m u� oo
ad the hrdoo ss maurbb mqui semen under CMpur 6.95 of me Cal ifor.
IN @ SafetyC.de, Satiera25505.25533 and 25534.1 mdcvertl thuifde building
it currently hew nant, dot h nt my reaponsloilily m ratify IM occupant of the
m94Whjch st metpdfminuaveofa CertiOcamof Occupancy.
PERMIT ISSUE DATE
Job Description
4lf a Z)�'Ino
Required Inspections
Issued by:
Re -roofs
Type of Roof
Date
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
all new materials for inspection.
SignWWe_ofAppjIicanr Date
All roof coverings to be Class "B" or better